3D Transoesophageal Echocardiography

3D TOE : The PM lead impedes normal closure of the tricuspid valve and is responsible for severe TR. Note that the posterior leaflet is immobile.

Diagnosis: Iatrogenic « functional » tricuspid regurgitation due to the pace maker lead

PACE MAKER INDUCED TR

Mild or moderate TR is frequently observed after PM implantation (1-2): the lead is almost always responsible for some degree of incomplete coaptation. Degree of TR increases with the number of leads crossing the tricuspid orifice

In cases of severe symptomatic tricuspid regurgitation caused by the PM lead, percutaneous or surgical material extraction with tricuspid valve repair or replacement should be discussed, depending on TR mechanism